Mobility, turnover and storage of pollutants in soils, sediments and waters : achievements and results of the EU project AquaTerra : a review.

AquaTerra is one of the first environmental projects within the 6th Framework program by the European Commission. It began in June 2004 with a multidisciplinary team of 45 partner organizations from 13 EU countries, Switzerland, Serbia, Romania and Montenegro. Results from sampling and modeling in 4 large river basins (Ebro, Danube, Elbe and Meuse) and one catchment of the Brévilles Spring in France led to new evaluations of diffuse and hotspot input of persistent organic and metal pollutants including dynamics of pesticides and polycyclic aromatic hydrocarbons, as well as metal turnover and accumulation. While degradation of selected organic compounds could be demonstrated under controlled conditions in the laboratory, turnover of most persistent pollutants in the field seems to range from decades to centuries. First investigations of long-term cumulative and degradation effects, particularly in the context of climate change, have shown that it is also necessary to consider the predictions of more than one climate model when trying to assess future impacts. This is largely controlled by uncertainties in climate model responses. It is becoming evident, however, that changes to the climate will have important impacts on the diffusion and degradation of pollutants in space and time that are just at the start of their exploration

Designing the primary mirror support for the E-ELT

Described is the M1 segment support, as designed by TNO in the period 2015- 2016. The design has significantly changed and improved compared to the earlier designs. During the period 2009-2010 prototypes for the primary mirror support of the E-ELT have been developed. These have been extensively tested by ESO. Design improvement were found to be necessary, especially in the field of manufacturability and maintainability. Furthermore, the technical performance had to improve in specific areas as well. This has evolved into a new specifications which have resulted in a new design for the segment support structure. The design rules that have led to the prototype design have been maintained but the implementation has been much improved. Also considerable improvement has been obtained with respect to the dynamic behavior. Accessibility and visibility on all parts and subsystems has changed such that everything is now clearly visible. Despite the increased performance no mass increase has been recorded meaning that more efficient use has been made of the material. The active means to influence the segment shape by use of the warping harness has been completely redesigned. A very important quality that has been achieved is simplicity. Hence a minimum amount of components is used. Reliability and safety are other aspects that have been greatly improved compared to the prototypes. The design for the M1 segment support provides an answer that not only performs to specification but one that can be operated in a telescope environment, all 798 of them

Prevalência dos sintomas otológicos na desordem temperomandibular: estudo de 126 casos Prevalence of otologic symptoms in temperomandibular disorders: 126 case studies

Introdução: A presença de sintomas otológicos associados à desordem temporomandibular (DTM) é discutida há seis décadas; entretanto, sua etiologia ainda permanece obscura. Forma de estudo: Prospectivo clínico randomizado. Objetivo: Neste estudo foram avaliadas a prevalência de sintomas otológicos na DTM, sua correlação com a dor muscular e a ausência de dentes posteriores. Material e Método: Foram avaliados 126 pacientes portadores de DTM, através de questionário subjetivo dos sintomas, palpação dos músculos de mastigação, temporal, masséter, pterigóideo lateral, pterigóideo medial, digástrico, tendão do músculo temporal e dos músculos esternocleidomastóideo e trapézio. Foram feitas radiografias panorâmica e transcraniana e modelos de gesso das arcadas superior e inferior dos pacientes. Os dados obtidos foram analisados através do Teste Exato de Fisher, com percentil de significância menor que 0,05. Resultados: Houve presença de sintomas otológicos em 80% dos pacientes, sendo que 50% apresentavam dor referida em ouvido; 52%, plenitude auricular; 50%, tinitus; 34%, tontura; 9%, sensação de vertigem; e 10% relataram hipoacusia. O músculo pterigóideo lateral foi o músculo mais sensível em 94% dos pacientes, seguido do músculo temporal em 69%, masséter em 62%, digástrico em 60%, pterigóideo medial em 50%, tendão do músculo temporal e esternocleidomastóideo em 49% e trapézio em 42% dos pacientes. Houve significância para dor muscular, e a presença de sintomas otológicos, nos músculos masséter e esternocleidomastóideo. Os sintomas tinitus, plenitude auricular e dor referida em ouvido apresentaram alta correlação de significância entre si. Não houve significância para a ausência de dentição e sintomas otológicos. Conclusão: 1) Dor referida em ouvido, tínitus, plenitude auricular e tontura foram prevalentes; 2) os sintomas otológicos presentes na DTM podem estar relacionados com a dor muscular em masséter e esternocleidomastóideo; 3) não houve correlação entre os sintomas otológicos e a ausência de dentes posteriores.<br>Introduction: A presence of otologic symptoms associated to the temporomandibular disorders (TMD) is discussed since six decades ago, however its etiology still stays obscure. Study design: Prospective clinical randomized. Aim: In that study it was appraised the prevalence of otologic symptoms in TMD, the correlation with the muscular pain and the absence of posterior teeth. Material and Methods: 126 patients, presented TMD, were appraised through questionnaire about their symptoms, palpation of the masticatory muscles, temporal, masseter, lateral pterygoid medial, pterigoyd, digastric, temporal muscle tendon, esternocleidomastoid and trapezius and panoramic and transcranian X-rays and plaster´s models of the superior and inferior arcades. The data obtained were analyzed through Exact Test of Fisher, with p value < 0,05. Results: The otologic symptoms were presented in 80% of the patients (50% presented hear pain 52% aural fullness, 50% tinitus, 34% dizziness, 9% sensation of vertigo and 10% told hypoacusis). The palpation revelated lateral pterigoyd as the most sensitive 94%, followed by the temporal muscle ( 69%), masseter (62%), digastric (60%), medial pterigoyd (50%), temporal muscle tendon and sternocleidomastoid (49%) and trapezius (42%). The muscular pain and otologic symptoms were statistically significant in the masseter and esternocleidomastoid muscles. Tinitus, aural fullness and otologic pain presented high significant correlation to each other. There was not significance between the absence of teeth and otologic symptoms. Conclusion: 1) otalgia, tinitus, aural fullness and dizziness were prevalentes 2) the otologic symptoms present in TMD can be relation with the muscular pain in masseter and esternocleidomastoid 3) there was not correlation between the otologic symptoms and the absence of posterior teeth

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P < 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P < 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -9·4 (95 per cent c.i. -11·9 to -6·9) per cent; P < 0·001), but the relationship was reversed in low-HDI countries (+12·1 (+7·0 to +17·3) per cent; P < 0·001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0·60, 0·50 to 0·73; P < 0·001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone